Fatal liver failure following food supplements during chronic treatment with montelukast

Actis, Giovanni C; Bugianesi, E.; Ottobrelli, A.; Rizzetto, M.

doi:10.1016/j.dld.2006.10.002

Cited by 33 publications

(23 citation statements)

References 9 publications

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“…Exilis ® contains, besides green tea, Garcinia cambogia, Gymnema sylvestre, chromium chelate, conjugated linoleic and others. G. cambogia has been hypothesized to have a synergistic hepatotoxic effect with montelukast in a fatal case of liver failure (Actis et al 2007) and in laboratory experiments has been shown to increase hepatic collagen accumulation, lipid peroxidation and mRNA levels of genes related to oxidative stress, as well as plasma alanine transaminase and aspartate transaminase levels (Kim et al 2013). G. sylvestre has been reported to induce hepatitis too (Shiyovich et al 2010).…”

Section: Discussionmentioning

confidence: 97%

Hepatotoxicity of green tea: an update

2015

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Green tea (GT), obtained from the leaves of Camellia sinensis (L.) Kuntze (Fam. Theaceae), is largely used for its potential health benefits such as reduction in risk of cardiovascular diseases and weight loss. Nevertheless, it is suspected to induce liver damage. Present work reviews the hepatic adverse reactions associated with GT-based herbal supplements, published by the end of 2008 to March 2015. A systematic research was carried out on PubMed, MedlinePlus, Scopus and Google Scholar databases, without any language restriction. Moreover, some accessible databases on pharmacovigilance or phytovigilance were consulted. The causality assessment was performed using the CIOMS/RUCAM score. Nineteen cases of hepatotoxicity related to the consumption of herbal products containing GT were identified. The hepatic reactions involved mostly women (16/19); the kind of liver damage was generally classified as hepatocellular (16/19). The causality assessment between consumption of herbal preparation and hepatic reaction resulted as probable in eight cases and as possible in eleven cases. In seven cases, patients used preparations containing only GT, while twelve reactions involved patients who took multicomponent preparations (MC). The reactions induced by GT had a generally long latency (179.1 ± 58.95 days), and the outcome was always resolution, with recovery time of 64.6 ± 17.78 days. On the contrary, liver injury associated with MC had a shorter latency (44.7 ± 13.85 days) and was more serious in four cases that required liver transplantation and, when resolution occurred, the recovery time was longer (118.9 ± 38.79). MC preparations contained numerous other components, many of which are suspected to induce liver damage, so it is difficult to ascribe the toxicity to one specific component, e.g., GT. Present data confirm a certain safety concern with GT, even if the number of hepatic reactions reported is low considering the great extent of use of this supplement. The mechanism of GT hepatotoxicity remains unclear, but factors related to the patient are becoming predominant. A major safety concern exists when GT is associated with other ingredients that can interact between them and with GT, enhancing the risk of liver damage. Patients should be discouraged from using herbal or dietary supplements containing complex mixtures and should be encouraged to use herbal and dietary supplement possibly under supervision of healthcare professionals.

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Section: Discussionmentioning

confidence: 97%

Hepatotoxicity of green tea: an update

2015

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“…G. cambogia was also a main active ingredient in the weight-loss supplement Hydroxycut ® (Iovate Health Sciences, Inc., Oakville, ON), which has known hepatoxicity[11-16]. In May 2009, the FDA issued a consumer warning recalling all Hydroxycut ® products due to 23 hepatotoxicity cases.…”

Section: Discussionmentioning

confidence: 99%

Dangerous dietary supplements:Garcinia cambogia-associated hepatic failure requiring transplantation

Lunsford¹,

Bodzin²,

Reino³

et al. 2016

WJG

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Commercial dietary supplements are marketed as a panacea for the morbidly obese seeking sustainable weight-loss. Unfortunately, many claims cited by supplements are unsupported and inadequately regulated. Most concerning, however, are the associated harmful side effects, often unrecognized by consumers. Garcinia cambogia extract and Garcinia cambogia containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we report the first known case of fulminant hepatic failure associated with this dietary supplement. One active ingredient in this supplement is hydroxycitric acid, an active ingredient also found in weight-loss supplements banned by the Food and Drug Administration in 2009 for hepatotoxicity. Heightened awareness of the dangers of dietary supplements such as Garcinia cambogia is imperative to prevent hepatoxicity and potential fulminant hepatic failure in additional patients.

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“…Nevertheless, HCA is a primary component of many weight loss supplements in the market, and similar to others in its class, the toxicity profile is poorly studied. In the recent literature a case of fatal liver failure was reported in a patient taking HCA and montelukast suggesting the synergistic hepatotoxic effect of these two agents [10] . There have also been reports of G. Cambogia toxicity by the WHO database, mostly describing an increase in hepatic enzymes [6] .…”

Section: Discussionmentioning

confidence: 99%